Healthcare Provider Details

I. General information

NPI: 1063917482
Provider Name (Legal Business Name): TARA LAKSHMI MAGGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 BEANER HOLLOW RD
BEAVER PA
15009-9722
US

IV. Provider business mailing address

1030 BEANER HOLLOW RD
BEAVER PA
15009-9722
US

V. Phone/Fax

Practice location:
  • Phone: 724-774-0778
  • Fax: 724-774-1109
Mailing address:
  • Phone: 724-774-0778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.141912
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD489098
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: